Archive for Healthcare Data Mining

ONC HIE framework a guide and ‘living document’

May 8, 2013 admin No comments

The Office of the National Coordinator for Health IT has published a governance framework for health information exchange aimed at helping HIEs and other health organizations “align their work with national priorities.”


The framework stems from, and is in part an alternative to, the now-abandoned pursuit of governance for the nationwide health information network. The ONC decided to discontinue the formal rulemaking process, national coordinator Farzad Mostashari, MD, explained, and “instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret.”


The framework is meant to provide a “common conceptual foundation applicable to all types of governance models and expresses the principles ONC believes are most important for HIE governance,” ONC officials wrote. Rather than prescribing “specific solutions,” it “lays out milestones and outcomes that ONC expects for and from HIE governance entities.”


The principles cover trust with patients, business management, organizational approaches for self-governance, and technical issues and standards.


The trust principles state that patients should be able to publicly access, in consumer-friendly language, a “Notice of Data Practices” explaining the reasons why personally identifiable and de-identified data would or could be electronically exchanged (among them treatment, payment, research, quality improvement, public health reporting and population health management).


According to the framework, patients should also be able to receive a simple explanation of an HIE’s privacy and security policies, be offered a choice for allowing personally identifiable information to be digitally shared, be able to request data exchange limits based on the data type or source (such as for substance abuse treatment), be able to digitally access and request corrections to their personally identifiable information, and be assured that their information is consistently and accurately matched when electronically exchanged.


HIE operations, according to the framework, should strive for transparency and openness, for providers, payers and patients, and should also have protocols for ensuring adherence to organizational policy and federal and state laws and regulations.


For HIE business principles, the framework states: “Responsible financial and operational HIE policy is vital to improving care coordination, improving the efficiency of healthcare delivery, and mitigating behaviors that could result in proprietary networks and resistance to exchanging information even when it could enhance patient care.”


The ONC is recommending that HIE organizations set standards of participation promoting collaboration and avoiding “instances where (even when permitted by law) differences in fees, policies, services, or contracts would prevent patients’ health information from being electronically exchanged.”


Additionally, the framework suggests, HIEs should provide open access to exchange services (like directory data) so local, regional and nationwide partners can identify who they can electronically exchange information with; publish statistics on exchange capacity and patient volume; and maintain and share information on compliance, standards, security, and best practices.


In its technical principles, ONC recommends that HIEs should “prioritize, where available, the exclusive use of federal vocabulary, content, transport and security standards, and associated implementation specifications adopted to support HIE.” Or, if not adopting federal standards, HIEs should encourage the vocabulary, content, transport, security standards, and implementation specifications developed by voluntary consensus standards organizations.


Following the framework, HIEs should work with voluntary consensus standards organizations to develop standards for specific use cases and volunteer to pilot and use new standards when none exist, and also “take an active role” in developing and implementing conformance assessment and testing methods for HIE, and use testing methods developed to assess compliance with federal standards.


The framework is intended be “a living document,” Mostashari explained, and ONC “will consider updating these principles over time to reflect policy changes, technological maturity, and market innovations, as necessary.”


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CHIME calls for Stage 2 delay

May 8, 2013 admin No comments

Responding to a feedback request from Senators on Capitol Hill regarding health IT adoption, the College of Healthcare Information Management Executives called for a one-year pushback of the Stage 2 meaningful use deadline and defended the efficacy of the federal incentive program. 


In a May 6 letter addressed to six Senators who have recently voiced skepticism over the current state of health IT, CHIME CEO Russell P. Branzell and CHIME Board Chair George T. Hickman wrote that a one-year extension of Stage 2 would “maximize the opportunity of program success.”  


With many providers struggling to meet Stage 1 requirements on top of additional regulations outlined in rules such as HIPAA and ICD-10, the industry needs the extra breathing room, CHIME officials say.    


The extra year “will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2,” wrote Branzell and Hickman. “It will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.”  


In calling for the Stage 2 extension, CHIME defended much of the federal incentive program’s progress to date, arguing that fundamental shifts in health IT adoption and EHR product capabilities have been made possible through meaningful use.  


“While we share some of your concerns with the current state of interoperability, we strongly believe that EHR incentive payments under the policy of meaningful use have been essential in moving the nation’s healthcare system into the 21st Century,” officials wrote. “Through the EHR Incentive Payments program, CMS and ONC have begun to mitigate a fractured and incompatible state for EHRs.”  


The response comes amid concerns levied by six Senators — John Thune, R-S.D.; Lamar Alexander, R-Tenn.; Pat Roberts, R-Kan.; Richard Burr, R-N.C.; Tom Coborn, R-Okla.; and Mike Enzi, R-Wyo. — that the current direction of the HITECH program is flawed. The Senators’ white paper released April 16 outlines several concerns including increased healthcare costs; torpid momentum toward interoperability; lack of administration oversight to properly prevent fraud and waste; patient privacy and long-term program sustainability.  


“It is unclear whether the HITECH Act has expanded the use of health IT in a meaningful, effective way,” the Senators wrote. “We have significant concerns with the implementation of the HITECH Act to date, including the lack of data to support the Administration’s assertions that this taxpayer investment is being appropriately spent and actually achieving the goal of interoperable health IT.”  


The Senators cited the $35 billion in incentive payments and grants authorized by ARRA, nearly $12.7 billion already paid out by CMS as of February. Nearly $1.2 billion was paid in December of 2012 alone. “With so many dollars flowing out of CMS, Congress has the fiduciary responsibility to ensure that these taxpayer dollars are being used to efficiently accomplish the end goal of reduced health care costs through the appropriate sharing and use of health information,” the white paper reads.   


CHIME officials stated that the Senators’ report “highlights a number of fair and responsible criticisms of the program,” echoing many of the concerns CHIME has voiced in the past three years. However, “given the nation’s increased adoption of EHRs, the increased investments in interoperable solutions and the early-stage transformations encountered every day by our members, we remain convinced that the trajectory set by meaningful use is the correct one,” wrote Branzell and Hickman.  


CHIME also urged Congress to request an update from ONC regarding what technologies, architectures and strategies exist to mitigate patient matching errors; seek feedback from the public via congressional hearing or other formal commenting mechanism; and determine how current work at the S&I Framework could be leveraged to address the foundational challenge of patient data-matching.  


Responding to a section of the white paper on audits and program integrity, CHIME said CIOs understand the desire to ensure that incentive payments are going to those who have qualified to receive them, but this intent must not result in unreasonable auditing efforts that are poorly structured, inconsistent or lack uniform criteria. “We ask that Congress ensure CMS audits are efficient and effective without overburdening providers,” the letter stated.


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4 HIX elements states should consider now

May 8, 2013 admin No comments


Consumers today like options. Whether it’s carefully weighing the cost of airline tickets or a new tech gadget, shopping comparison sites like Kayak or Amazon help us feel confident that we are getting the best product at the lowest price possible. Savvy consumers will soon be able to apply the same approach to healthcare when health insurance marketplaces go into effect this fall.


States are required to have health insurance marketplaces — a key component of the Affordable Care Act (ACA) — up and running to accept participants for open enrollment by October of this year. Millions will become eligible for expanded insurance options under the ACA as states are now charged with making healthcare more accessible and more affordable for Americans.


Following the Supreme Court’s decision last June to uphold the ACA, states were given three paths to choose from: a state-based marketplace; a state/federal partnership; or a federally-facilitated marketplace. These government-sponsored portals are where people will compare and purchase health insurance plans for themselves, their families or their businesses.


No matter the model of marketplace states have chosen, however, they all share one common challenge: determining the most effective way to manage the influx of questions from citizens, who are seeking information about how the new marketplaces will affect their access to healthcare.


State governments have a big job ahead of them as they begin to educate the public. The next several months will likely be complicated and uncertain as marketplaces are established and benefit plans are finalized. Many people will need a degree of hand-holding to decide what healthcare option is right for them — and that means phones could be ringing off the hook in each of the 50 states.


According to a recent survey from the Kaiser Family Foundation, 48 percent of citizens are unsure whether or not their state will run its own marketplace.


It has become increasingly critical for states to fill the knowledge gap by making messaging accessible to consumers so they better understand the massive shift occurring in the healthcare system.


Most have been steadily adopting new technology-based innovations to achieve a “no wrong door” system, and nearly all offer in-person assistance in eligibility offices or a toll-free hotline to help consumers enroll in Medicaid or CHIP. For those citizens who want or need one-on-one support, states will still need to build on their existing base of citizen assistance resources, particularly call centers, to connect people to coverage.


As states implement these and other changes associated with the health insurance marketplace, there are four key elements to keep in mind:

Create a consumer-friendly experience – In today’s mobile world, people are accustomed to having multiple communication options. That means citizens will look for a variety of choices, from the telephone to Web portals, to obtain accurate information about the new mandates. States should identify a partner with proven call center expertise, as well as a deep knowledge of healthcare policy and programs, to guarantee the most effective consumer assistance.Address underlying technical issues – States need a reliable system in place to help answer the many questions that consumers are likely to have as they join marketplaces. They must be prepared to complete applications over the phone for those citizens who cannot access a computer or don’t know where to access the application. Trained, professional agents and best-in-class technology will help ensure residents are well supported in making their healthcare selections.Connect all necessary parties – From healthcare consumers and insurance carriers, to banking partners and human resource departments, state governments must be mindful of the various individuals and organizations touched by these new processes. States need accessible, timely messaging to help all those involved better understand the necessary provisions and changes. Comply with associated regulations – States have very little margin for error in getting a marketplace ready to provide affordable care. Each state must begin open enrollment by October 2013, provide coverage by January 2014 and be self-sustainable by 2015. States must also coordinate services across all agencies, including Medicaid, CHIP, SNAP and TANF. It may prove difficult to manage parallel implementations, so states should be cognizant of the extra demand ACA regulations can place on resources.

One state successfully addressing these challenges now with a strategic plan that places strong emphasis on engaging consumers is Nevada. The state’s marketplace, Nevada Health Link, acts as a bridge between public and private healthcare programs. Sitting on one side of the “bridge” is Nevada’s eligibility system, its main location for Medicaid and CHIP systems information. On the other side is the Qualified Health Plan enrollment-related business operations system.


Nevada Health Link will provide a single point of entry for the state’s pre-existing Medicaid and CHIP programs, as well as its new health insurance marketplace, which will connect the eligibility and healthcare systems, allowing them to communicate with each other at several interfaces. In this way, all public and commercial program application, eligibility and enrollment will come through Nevada Health Link, making it the central hub for all the state’s health insurance programs.


Nevada Health Link will create a simplified experience for consumers and a flexible one for the state, which can maintain control over both the health insurance marketplace and its insurance market, while building in customizations and without sacrificing timeliness.


This makes it easy to see how health insurance marketplaces can serve as conduits between systems and important facilitators for streamlining and speeding health plan purchasing and other state eligibility processes. And with the right system is in place, states will have the foundation needed for a successful health insurance marketplace that best serves its citizens.


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CO Beacon shows progress amid hurdles

May 8, 2013 admin No comments

When the ONC launched the Beacon Community grants in 2009, several health organizations in western Colorado, which five years earlier formed the HIE Quality Health Network, saw the program as a natural extension of their work towards IT-enabled hospital and primary care improvements.


With a three-year $11.9 million federal grant, the Mesa County Independent Practice Association, Rocky Mountain Health Plans and St. Mary’s Regional Medical Center formed the Colorado Beacon Consortium, aiming to help physicians and hospitals establish local medical neighborhood models and use EHRs, information exchange and analytics.


Although some practices still face technical challenges, the project has helped usher in a more team-based approach to care coordination and has spurred greater interest in process and system improvement among providers, according to a Commonwealth Fund case study.


The Beacon Consortium signed on 51 of the 75 primary care practices invited to join the learning collaborative, and covers seven western Colorado counties, in a region where St. Mary’s Regional Medical Center, in Grand Junction, is the only tertiary hospital in the 500 mountainous miles separating Denver and Salt Lake City.


Starting from the premise that primary care physicians are “the key healthcare decision-makers in rural communities,” the Colorado Beacon laid out two improvement tracks — spreading health IT regionally, with the HIE supporting population health tools like risk stratification and predictive modeling, and redesigning primary care processes for quality improvement and measurements.


To join the Beacon, physicians were not required to have an EHR or to participate in the Quality Health Network HIE (which is powered by UnitedHealth Group’s OptumInsight), although most did.


As of late December, 41 of the 51 practices were using an EHR and eight were using a Quality Health Networks-based “EHR-lite” web portal, considered an intermediate step to full EHR adoption.


Although much of the Beacon’s initial work was helping practices and providers with IT issues, the consortium was also “selling a concept — a better way of doing things — not a product,” Mike Lloyd, the director of data processing at the 75-bed Montrose Memorial Hospital, told the Commonwealth Fund.


The basic concept was connecting primary care practices, critical access hospitals, regional hospitals like Montrose and large health systems like St. Mary’s.


Leaders at Montrose hospital in particular cheered the decline of faxes they had to receive from smaller clinics, according to the case study. And with incentives being offered by Rocky Mountain Health Plans, Mesa County physicians have been documenting quality measures with the HIE’s population health registry tool, and the same tools are now being adopted by doctors outside of Mesa County in meaningful use attestation.


About 85 percent of physicians in the participating areas are now connected to the HIE in participating medical neighborhoods, and Quality Health Networks is launching several clinical decision support tools, including a master patient-registry that aggregates data from all providers in the HIE to create a longitudinal view of patient history and a risk-stratification and predictive-modeling program (now just getting off the ground) that analyzes clinical and claims data.


[Podcast: A site visit to Hawaii's Beacon Community]


At the same time, the case study found, some doctors close to retirement in the seven-county area have chosen to forgo IT investments and HIE participation, while some others have faced technical challenges with EHR systems.


Since many physicians continue to dictate narrative clinical notes, EHR data extraction is one common problem, the study found, and so many EHR companies have created free-text functions, “which make the EHR more of a word processor than a structured database that can be queried for aggregating and reporting results.”


Until there are functions guiding clinicians with key data elements in standard terminology that can be linked from EHR to EHR and until natural language processing algorithms can be used for extracting relevant data from notes, the HIE is largely serving to transfer unstructured clinical notes between EHRs — losing some IT efficiency-gains when that data is reentered.


But as the Commonwealth Fund noted, several of the 17 Beacon communities are working with EHR companies and the ONC to craft exchange standards that should alleviate those issues in the future, with a consensus reached recently on the minimum set of elements for patient records summary and performance reporting.


And the Beacon program has helped providers start to use IT tools to adapt to broader industry shifts.


The Colorado Beacon, said Tim Burns, chief administrative officer at the 16-doctor practice Glenwood Medical Associates, “brought us above the forest to look over the top of the trees and see the opportunities where significant change can occur in the industry and perhaps be a part of that.”


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Survey: Hospitals unprepared for ICD-10

May 8, 2013 admin No comments

The pace at which hospital administrators, health information professionals and compliance employees are moving toward the ICD-10 transition has elicited concern among industry leaders, according to a new survey that finds some 20 percent of small- and mid-sized hospitals have yet to begin any education or training for what’s been billed as one of the biggest shifts U.S. healthcare organizations have ever faced.


The survey, conducted by Health Revenue Assurance Associates, included the responses from more than 120 hospitals and found that nearly half are lagging behind on the Centers for Medicare & Medicaid Services timelines for ICD-10 preparation.


“The shift from ICD-9 to ICD-10 is equivalent to learning another language; it will not be as easy as flipping a switch,” said Andrea Clark, chief executive officer of HRAA, in a press statement. “HIM coders must be exposed and then trained on the fundamentals of ICD-10 to ensure that a hospital’s revenue system remains intact and that millions will not be left on the table when the transition takes place.”  


Of the hospitals surveyed:
40 percent have not begun ICD-10 CM training for coding staff;
55 percent have not begun ICD-10-PCS training for coding staff;
47 percent have not begun document improvement education for medical staff;
31 percent do not plan to dual code prior to Oct. 1, 2014.


“Education and training is the technical lock for ICD-10 dual coding,” Clark added. “Documentation improvement is the key foundation for dual coding efforts for both inpatient and outpatient encounters. Hospital’s ICD-10 coded data tomorrow is only as good as the documentation provided today. A hospital with a lock and key will open the benefits for dual coding.”  
While CMS recommends that hospitals conduct internal and external testing in 2013, the majority of respondents stated that they do not plan to start to dual code accounts until 2014. Twenty five percent plan to start in January 2014; 24 percent plan to start in April 2014; and 13 percent plan to begin in July 2014 or later.
The Workgroup for Electronic Data Interchange, health IT advisor group to the HHS, has also conducted ICD-10 readiness surveys since 2009, and its 2013 survey echo similar findings — more than 40 percent of healthcare providers have yet to conduct impact assessments, implement business changes and begin external testing


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